Impulsivity profiles across five harmonized longitudinal childhood preventive interventions and associations with adult outcomes.

This study aimed to parse between-person heterogeneity in growth of impulsivity across childhood and adolescence among participants enrolled in five childhood preventive intervention trials targeting conduct problems. In addition, we aimed to test profile membership in relation to adult psychopathologies. Measurement items representing impulsive behavior across grades 2, 4, 5, 7, 8, and 10, and aggression, substance use, suicidal ideation/attempts, and anxiety/depression in adulthood were integrated from the five trials (N = 4,975). We applied latent class growth analysis to this sample, as well as samples separated into nonintervention (n = 2,492) and intervention (n = 2,483) participants. Across all samples, profiles were characterized by high, moderate, low, and low-increasing impulsive levels. Regarding adult outcomes, in all samples, the high, moderate, and low profiles endorsed greater levels of aggression compared to the low-increasing profile. There were nuanced differences across samples and profiles on suicidal ideation/attempts and anxiety/depression. Across samples, there were no significant differences between profiles on substance use. Overall, our study helps to inform understanding of the developmental course and prognosis of impulsivity, as well as adding to collaborative efforts linking data across multiple studies to better inform understanding of developmental processes.

Managing the Dual Diagnosis Dilemma of Bipolar Disorder and Substance Abuse in Clinical Settings.

OBJECTIVE: Drug addiction is a chronic mental disorder that significantly impacts all aspects of an individual's life, and substance use disorder in patients with bipolar disorder. The objective of this study is to assess the frequency of substance abuse among patients with bipolar spectrum disorder. METHOD: This cross-sectional study evaluated the frequency of bipolar spectrum disorder in patients taking methadone through various screening measures, including Mini Mental State Examination (MMSE), DSM IV criteria, Mood Disorders Questionnaire (MDQ), Goodwin and Ghaemi's criteria, and Akiskal classification for bipolar disorders. RESULTS: Out of the total 197 participants in the study, 77 were identified as individuals engaging in poly-substance abuse. The investigation assessed the frequency of bipolar spectrum disorder based on various diagnostic criteria: 24% according to DSM-IV criteria, 29.9% using MDQ, 29.9% based on Ghaemi and Goodwin's criteria, and the highest rate at 48.2% when applying Akiskal's classification. CONCLUSIONS: This study highlights the high frequency of bipolar disorder among individuals with substance use disorder, especially those with concomitant depression. Therefore, it is crucial to pay special attention to individuals with substance use disorder with co-existing bipolar disorder.

Prevalence and determinants of opioid use disorder among long-term opiate users in Golestan Cohort Study.

BACKGROUND: Number of opiate users worldwide has doubled over the past decade, but not all of them are diagnosed with opioid use disorder. We aimed to identify the prevalence and risk factors for OUD after ten years of follow-up. METHODS: Among 8,500 chronic opiate users at Golestan Cohort Study baseline (2004-2008), we recalled a random sample of 451 subjects in 2017. We used three questionnaires: a questionnaire about current opiate use including type and route of use, the drug use disorder section of the Composite International Diagnostic Interview lifetime version, and the validated Kessler10 questionnaire. We defined opioid use disorder and its severity based on the DSM-5 criteria and used a cutoff of 12 on Kessler10 questionnaire to define psychological distress. RESULTS: Mean age was 61.2 ± 6.6 years (84.7% males) and 58% were diagnosed with opioid use disorder. Starting opiate use at an early age and living in underprivileged conditions were risk factors of opioid use disorder. Individuals with opioid use disorder were twice likely to have psychological distress (OR = 2.25; 95%CI: 1.44-3.52) than the users without it. In multivariate regression, former and current opiate dose and oral use of opiates were independently associated with opioid use disorder. Each ten gram per week increase in opiate dose during the study period almost tripled the odds of opioid use disorder (OR = 3.18; 95%CI: 1.79-5.63). CONCLUSIONS: Chronic opiate use led to clinical opioid use disorder in more than half of the users, and this disorder was associated with psychological distress, increasing its physical and mental burden in high-risk groups.

Validity of self-reports of medication treatment of depression in general population surveys.

PURPOSE: To assess the concurrent validity of a single question on medication use for depression in a general population survey. METHODS: Using data from 2015 to 2016 and 2017 to 2018 National Health and Nutrition Examination Survey, we compared responses to a single question on medication use for depression with responses to a detailed questionnaire confirmed by inspecting medication packages or pharmacy printouts. RESULTS: There was a strong agreement (96.4%) between response to a single question about using medication for depression and responses to questions about using antidepressants or other psychiatric medications for depression on the detailed questionnaire. The single-question assessment had excellent sensitivity (93.8%) and specificity (96.7%), positive predictive value (71.5%), and kappa (0.79). Psychometric properties were mostly consistent across population subgroups. CONCLUSIONS: Single-question assessments of medication use for depression have acceptable concurrent validity against more detailed assessments and provide an efficient method for assessing medication treatment of depression in population health surveys.

Data management in substance use disorder treatment research: Implications from data harmonization of National Institute on Drug Abuse-funded randomized controlled trials.

BACKGROUND: Secondary analysis of data from completed randomized controlled trials is a critical and efficient way to maximize the potential benefits from past research. De-identified primary data from completed randomized controlled trials have been increasingly available in recent years; however, the lack of standardized data products is a major barrier to further use of these valuable data. Pre-statistical harmonization of data structure, variables, and codebooks across randomized controlled trials would facilitate secondary data analysis, including meta-analyses and comparative effectiveness studies. We describe a pre-statistical data harmonization initiative to standardize de-identified primary data from substance use disorder treatment randomized controlled trials funded by the National Institute on Drug Abuse available on the National Institute on Drug Abuse Data Share website. METHODS: Standardized datasets and codebooks with consistent data structures, variable names, labels, and definitions were developed for 36 completed randomized controlled trials. Common data domains were identified to bundle data files from individual randomized controlled trials according to relevant concepts. Variables were harmonized if at least two randomized controlled trials used the same instruments. The structures of the harmonized data were determined based on the feedback from clinical trialists and substance use disorder research experts. RESULTS: We have created a harmonized database of variables across 36 randomized controlled trials with a build-in label and a brief definition for each variable. Data files from the randomized controlled trials have been consistently categorized into eight domains (enrollment, demographics, adherence, adverse events, physical health measures, mental-behavioral-cognitive health measures, self-reported substance use measures, and biologic substance use measures). Standardized codebooks and concordance tables have also been developed to help identify instruments and variables of interest more easily. CONCLUSION: The harmonized data of randomized controlled trials of substance use disorder treatments can potentially promote future secondary data analysis of completed randomized controlled trials, allowing combining data from multiple randomized controlled trials and provide guidance for future randomized controlled trials in substance use disorder treatment research.

Hepatitis B virus infection among people who use drugs in Iran: a systematic review, meta-analysis, and trend analysis.

BACKGROUND: People who use drugs (PWUD) are considered as one of the main at-risk populations for Hepatitis B virus (HBV) infection. We conducted a systematic review on the prevalence of HBV infection among PWUD in Iran. METHODS: Consistent with PRISMA guideline, international (Medline, Web of Science, Scopus, and Embase) and national (Scientific Information Database) databases were searched using a comprehensive search strategy up to September 2019. The retrieved records were reviewed, and experts were contacted for unpublished studies. Studies on Iranian PWUD reporting HBV surface Antigen (HBsAg) prevalence among people who inject drugs (PWID) and non-injecting PWUD were included. HBsAg prevalence was pooled for PWID and non-injecting PWUD and for other subgroups using random-effects model meta-analysis. The trend of HBV prevalence over time was investigated using meta-regression analysis. RESULTS: Overall, 35 studies reported data on HBV infection among PWID (33 studies) and non-injecting PWUD (11 studies). The pooled prevalence of HBsAg among PWID was 4.8% (95% CI 3.7-6.2). The only risk factor significantly associated with the odds of positive HBsAg in PWID was the previous history of imprisonment (OR 1.72, 95% CI 1.29-2.30, p value = 0.000). The pooled estimate of HBsAg among non-injecting PWUD was 2.9% (95% CI 2.5-3.2). Time trend analyses showed significant decrease in HBV prevalence among PWID reaching from 8.2% (95% CI 3.9-16.5) in 2004-2006 to 3.1% (95% CI 2.3-4.1) in 2016 and later (b = -0.07; p value = 0.05). No significant trend was detected for non-injecting PWUD. CONCLUSION: The prevalence of HBV infection among non-injecting PWUD and even PWID was not considerably higher than the Iranian general population. This might be the result of extensive harm reduction interventions in Iran. However, it seems that there are subgroups of PWID, who do not adequately benefit from existing harm reduction interventions. Future programs should more specifically target these high-risk groups.

Validation of Addiction Severity Index (ASI) for Assessment of Psychiatric Comorbidity in Multi-Site Randomized Controlled Trials.

Objective: This study aimed to assess the validity of the psychiatric problems subscale of the Addiction Severity Index (ASI-psych) to ascertain psychiatric comorbidity among individuals participating in randomized controlled trials (RCTs) of substance use disorder (SUD) treatments.Methods: The ASI-psych score among 1,660 RCT participants of National Institute of Drug Abuse Clinical Trials Network studies was compared against diagnosis of any serious mental disorder based on the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (SCID) or Mini-International Neuropsychiatric Interview (MINI). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) for detecting any serious mental disorders were estimated by the receiver operating characteristic (ROC) analysis.Results: Based on the overall sample, the AUC score for any serious mental disorder was 0.72 (95% confidence interval [CI], [0.69, 0.75]) with the optimal ASI-psych score of 24.6. There was no statistically significant difference in AUCs based on the SCID and MINI (χ2 = 0.05, p = .82) or by target drugs of RCTs (χ2 =1.33, p = .72).Conclusions: Results support the utility of the ASI in screening for psychiatric comorbidity among patients receiving SUD treatments in RCT settings.

Misuse of prescribed opioids in the United States.

PURPOSE: To assess the prevalence and correlates of self-reported misuse of prescribed-opioid medications in the US general population. METHOD: In 31 068 adult participants of the National Survey on Drug Use and Health (NSDUH) 2015 and 2016 who reported using opioids in the past year, we assessed the prevalence and correlates of self-reported misuse of prescribed opioids, defined as using a larger dose, more frequently, or longer than prescribed. Multivariable logistic-regression models and the machine-learning method of boosted regression were used to identify the correlates of misuse. RESULTS: On the basis of weighted NSDUH estimates, of more than 89 million US adults who used prescription opioids every year, close to 3.9 million (4.4%) reported misused the prescribed medications. Prescribed-opioid misuse was most strongly associated with co-occurring misuse of opioids without a prescription, misuse of benzodiazepines, other drug-use disorders, history of illegal activity, and psychological distress. Misuse of prescribed opioids was also strongly associated with prescription opioid-use disorder, especially among those who misused more potent opioids or started misusing opioids before the current year. CONCLUSIONS: Misuse of prescribed opioids is associated with other high-risk behaviors and adverse health outcomes. The findings call for better monitoring of opioid prescription in clinical practice.

Major anxiety disorders in Iran: prevalence, sociodemographic correlates and service utilization.

BACKGROUND: It has been shown in the past two decades that anxiety disorders are the most common mental disorders in general population across the world. This study sought to assess the prevalence of major anxiety disorders, their sociodemographic correlates and mental health service utilization as part of the Iranian Mental Health Survey (IranMHS). METHODS: A national household face-to-face survey was carried out on a representative sample of Iranian adults from January to June 2011 using Composite International Diagnostic Interview (CIDI 2.1). A total of 7886 subjects between 15 and 64 years who can understand Persian language were included. The 12-month prevalence of anxiety disorders according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), their socio-demographic correlates, health service use and days out of role were measured in this study. RESULTS: The 12-month prevalence of anxiety disorders (not including specific phobias) was 15.6%. The prevalence was 12.0% in males and 19.4% in females. The three most prevalent anxiety disorders were generalized anxiety disorder (5.2%), obsessive-compulsive disorder (5.1%) and social phobia (3.2%), respectively. Factors found to be significantly associated with anxiety disorders were: female gender (OR = 1.16, 95% CI: 1.09-1.23), middle (OR = 1.23, 95%CI: 1.01-1.50) or low (OR = 1.66, 95%CI: 1.31-2.10) socioeconomic status, unemployment (OR = 1.98, 95%CI: 1.49-2.62), and urban residence (OR = 1.31, 95%CI: 1.10-1.57). Comorbidity with non-anxiety disorders significantly increased service utilization. In all subgroups, service utilization was higher among females while the number of days out of role was higher among males. CONCLUSIONS: Anxiety disorders are common conditions with a higher prevalence among the female gender, unemployed individuals, and people with low socioeconomic conditions living in urban areas. Comorbidity of anxiety disorders with other psychological disorders aggravates the disability and significantly increases the number of days out of role.

Pharmacological therapies for management of opium withdrawal.

BACKGROUND: Pharmacologic therapies for management of heroin withdrawal have been studied and reviewed widely. Opium dependence is generally associated with less severe dependence and milder withdrawal symptoms than heroin. The evidence on withdrawal management of heroin might therefore not be exactly applicable for opium. OBJECTIVES: To assess the effectiveness and safety of various pharmacologic therapies for the management of the acute phase of opium withdrawal. SEARCH METHODS: We searched the following sources up to September 2017: CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, regional and national databases (IMEMR, Iranmedex, and IranPsych), main electronic sources of ongoing trials, and reference lists of all relevant papers. In addition, we contacted known investigators to obtain missing data or incomplete trials. SELECTION CRITERIA: Controlled clinical trials and randomised controlled trials on pharmacological therapies, compared with no intervention, placebo, other pharmacologic treatments, different doses of the same drug, and psychosocial intervention, to manage acute withdrawal from opium in a maximum duration of 30 days. DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures expected by Cochrane. MAIN RESULTS: We included 13 trials involving 1096 participants. No pooled analysis was possible. Studies were carried out in three countries, Iran, India, and Thailand, in outpatient and inpatient settings. The quality of the evidence was generally very low.When the mean of withdrawal symptoms was provided for several days, we mainly focused on day 3. The reason for this was that the highest severity of opium withdrawal is in the second to fourth day.Comparing different pharmacological treatments with each other, clonidine was twice as good as methadone for completion of treatment (risk ratio (RR) 2.01, 95% confidence interval (CI) 1.69 to 2.38; 361 participants, 1 study, low-quality evidence). All the other results showed no differences between the considered drugs: baclofen versus clonidine (RR 1.06, 95% CI 0.63 to 1.80; 66 participants, 1 study, very low-quality evidence); clonidine versus clonidine plus amantadine (RR 1.03, 95% CI 0.86 to 1.24; 69 participants, 1 study); clonidine versus buprenorphine in an inpatient setting (RR 1.04, 95% CI 0.90 to 1.20; 1 study, 35 participants, very low-quality evidence); methadone versus tramadol (RR 0.95, 95% CI 0.65 to 1.37; 1 study, 72 participants, very low-quality evidence); methadone versus methadone plus gabapentin (RR 1.17, 95% CI 0.96 to 1.43; 1 study, 40 participants, low-quality evidence), and tincture of opium versus methadone (1 study, 74 participants, low-quality evidence).Comparing different pharmacological treatments with each other, adding amantadine to clonidine decreased withdrawal scores rated at day 3 (mean difference (MD) -3.56, 95% CI -5.97 to -1.15; 1 study, 60 participants, very low-quality evidence). Comparing clonidine with buprenorphine in an inpatient setting, we found no difference in withdrawal symptoms rated by a physician (MD -1.40, 95% CI -2.93 to 0.13; 1 study, 34 participants, very low-quality evidence), and results in favour of buprenorpine when rated by participants (MD -11.80, 95% CI -15.56 to -8.04). Buprenorphine was superior to clonidine in controlling severe withdrawal symptoms in an outpatient setting (RR 0.35, 95% CI 0.19 to 0.64; 1 study, 76 participants). We found no difference in the comparison of methadone versus tramadol (MD 0.04, 95% CI -2.68 to 2.76; 1 study, 72 participants) and in the comparison of methadone versus methadone plus gabapentin (MD -2.20, 95% CI -6.72 to 2.32; 1 study, 40 participants).Comparing clonidine versus buprenorphine in an outpatient setting, more adverse effects were reported in the clonidine group (1 study, 76 participants). Higher numbers of participants in the clonidine group experienced hypotension at days 5 to 8, headache at days 1 to 8, sedation at days 5 to 8, dizziness and dry mouth at days 1 to 10, and nausea at days 1 to 9. Sweating was reported in a significantly higher number of participants in the buprenorphine group at days 1 to 10. We found no difference between groups for all the other comparisons considering this outcome.Comparing different dosages of the same pharmacological detoxification treatment, a high dose of clonidine (1 to 1.2 mg/day) did not differ from a low dose of clonidine (0.5 to 0.6 mg/day) in completion of treatment in an inpatient setting (RR 1.00, 95% CI 0.84 to 1.19; 1 study, 68 participants), however a higher number of participants with hypotension was reported in the high-dose group (RR 3.25, 95% CI 1.77 to 5.98). Gradual reduction of methadone was associated with more adverse effects than abrupt withdrawal of methadone (RR 2.25, 95% CI 1.02 to 4.94; 1 study, 20 participants, very low-quality evidence). AUTHORS' CONCLUSIONS: Results did not support using any specific pharmacological approach for the management of opium withdrawal due to generally very low-quality evidence and small or no differences between treatments. However, it seems that opium withdrawal symptoms are significant, especially at days 2 to 4 after discontinuation of opium. All of the assessed medications might be useful in alleviating symptoms. Those who receive clonidine might experience hypotension.

Global Scientific Production on Illicit Drug Addiction: A Two-Decade Analysis.

AIMS: Addiction science has made great progress in the past decades. We conducted a scientometric study in order to quantify the number of publications and the growth rate globally, regionally, and at country levels. METHODS: In October 2015, we searched the Scopus database using the general keywords of addiction or drug-use disorders combined with specific terms regarding 4 groups of illicit drugs - cannabis, opioids, cocaine, and other stimulants or hallucinogens. All documents published during the 20-year period from 1995 to 2014 were included. RESULTS: A total of 95,398 documents were retrieved. The highest number of documents were on opioids, both globally (60.1%) and in each of 5 continents. However, studies on cannabis showed a higher growth rate in the last 5-year period of the study (2010-2014). The United States, the United Kingdom, Germany, Canada, Australia, France, Spain, Italy, China, and Japan - almost all studies were from high-income countries - occupied the top 10 positions and produced 81.4% of the global science on drug addiction. CONCLUSION: As there are important socio-cultural differences in the epidemiology and optimal clinical care of addictive disorders, it is suggested that low- and more affected middle-income countries increase their capacity to conduct research and disseminate the knowledge in this field.

Cluster analysis of psychiatric profile, its correlates, and using mental health services among the young people aged 15-34: findings from the first phase of Iranian youth cohort in Ravansar.

PURPOSES: (1) Cluster analysis of psychiatric disorders and partitioning the youth; (2) determining socio-demographic correlates and parental histories for each one of the clusters; and (3) comparing clusters based on the extent and type of using psychotherapeutic services. METHODS: The current cross-sectional study is a part of the first phase of PERSIAN Youth Cohort. The sample of the study includes 2991 participants aged 15-34 (27 ± 5.1 years, 55.6% female) from Ravansar district in western Iran. Enrollment and data collection for this phase were performed from October, 2014 to January, 2017. The data were collected through structured interviews, including the Composite International Diagnostic Interview (CIDI; version 2.1), mental health-related Sheehan Disability Scale, and Service Use Questionnaire. The obtained data were analyzed using two-step cluster analysis, multinomial logistic regression, and Chi-square test. RESULTS: Our model proposed three clusters: a clinical cluster with significant mental disability; a healthy cluster with significant disability; and a healthy cluster with mild disability. There is a direct relationship between widow/divorced marital status and psychiatric maternal history with the clinical cluster (P < 0.05). Clinical and non-clinical clusters with medium to severe disability used services for mental health more often that the healthy cluster with mild functional disability (P < 0.05). CONCLUSIONS: The results of the study show that 28.7% of the youth in the general population of western Iran are suffering from psychiatric disorders and nearly two-thirds of the total population reported a medium-severe functional disability. Considering the wide range of mental disorders and the functional disability levels created by these disorders, cluster analysis could provide invaluable information regarding the partitioning of the youth population.

Drop-out from a drug treatment clinic and associated reasons.

The aim of this study was to assess drop-out rates and associated reasons among patients at the Iranian National Center for Addiction Studies (INCAS) clinic. In a one-year period (April 2014 to March 2015), all patients with drug dependence who had been referred for treatment and attended for a first assessment were included in this study (N=242). Those who received treatment were followed until March 2016. Survival analysis showed that 70.2% had dropped out from treatment. Log rank test showed that treatment drop-out rates differed between the different approaches used (P < 0.001), with the lowest slope inbuprenorphine maintenance treatment and the highest in the detoxification programme. Drop-out rates within the first three months was 62% (SE= 0.05) and 82.4% (SE=0.03) for opioids and stimulants dependence, respectively. Analyses were performed using SPSS (Version 21.0) and STATA software, (version 13.0). From the patients' perspective, motivational inconsistencies were considered as the main reason for not starting or leaving treatment. The findings of this study could give service providers a better grasp of drop-out rates and the associated reasons.

Out-of-pocket cost of drug abuse consequences: results from Iranian National Mental Health Survey.

Drug abuse has significant cost to the individual, the family and the society. This study aimed to assess out of-pocket costs of consequences of drug use disorder. Data were drawn from the Iranian Mental Health Survey (IranMHS) through face-to-face interviews with 7841 respondents aged 15-64 years. We used a bottom-up cost-ofillness method for economic analysis. Out-of-pocket costs for treatment of mental and drug problems, treatment of medical illnesses, as well as costs of crimes were assessed. The average of total annual expense was US$ 2120.6 for those with drug use disorder, which was 23.5% of annual income of an average Iranian family in the year 2011. The average of total out-of-pocket cost was US$ 674.6 for those with other mental disorder and US$ 421.9 for those with no mental disorder. Catastrophic payment was reported in 47.6% of the patients with drug use disorder and 14.4% of those with other mental disorder. Thus, considerable amount of family resources are spent on the consequences of drug use.

Use of amphetamine-type stimulants in the Islamic Republic of Iran, 2004-2015: a review.

Amphetamine-type stimulants (ATS) are the second most commonly used illicit drugs in the world, after cannabis. The production of ATS has increased worldwide, including in the Middle East. This review aims to assess ATS use in the Islamic Republic of Iran. PubMed, Scientific Information Database (a national database) and Iranian Center for Addiction Studies were searched. The review included studies on the general population, university and high school students, other specific populations, and drug users. The result show that self-reported methamphetamine and ecstasy use in 2016 was < 1% in the general population and university and high-school students, but the prevalence was higher in certain groups. There has also been an increase in the proportion of ATS users among clients of drug treatment centres. The findings highlight the need for high quality epidemiological studies and closer monitoring of stimulant use in different populations.

Explaining socioeconomic inequalities in illicit drug use disorders in Iran.

Background: Drug use disorders are one of the major health problems in societies, which cause physical, psychological, and social damages to individuals. Socioeconomic status is often inversely associated with drug use disorders. The present study aimed at determining the effect of socioeconomic inequality on the prevalence of drug use disorders and identifying its determinants in Iran. Methods: Data of 7886 individuals aged 15 to 64 years were collected from Iran Mental Health Survey (IranMHS). Initially, the socioeconomic status of the participants was determined by principal component analysis. Later, socioeconomic inequality was measured using the concentration index, and the factors influencing the gap between the high and low socioeconomic groups were identified using the Oaxaca-Blinder Decomposition. Results: The concentration index for drug use disorders in Iran was -0.29 (standard error= 0.06). The results of decomposition technique revealed that 1.14% and 2.7% of the participants with high and low socioeconomic status were affected by drug use disorders, respectively. In addition, the gap between these 2 groups was found to be 1.65%. Among the studied variables, occupation, marital status, and gender accounted for the highest contribution to inequality, respectively. Conclusion: There is inequality in the prevalence of drug use disorders in Iran; these disorders are more common in lower socioeconomic group. Based on the findings, it is suggested that improvement in the socioeconomic status of the households, especially for males, the divorced or widowed individuals, and the unemployed may lead to a reduction in inequality in drug use disorders.

Latent class analysis of DSM-5 criteria for opioid use disorders: results from the Iranian National Survey on Mental Health.

BACKGROUND: Assessments of DSM-IV and DSM-5 criteria with sample populations of opioid users are limited. This study aimed to determine the number of latent classes in opioid users and assessment of the proposed revisions to the DSM-5 opioid use disorder (OUD) criteria. METHODS: Data came from the 2011 Iranian National Mental Health Survey (IranMHS) on 7,886 participants aged 15-64 years living in Iran. We used the Composite International Diagnostic Interview (CIDI) version 2.1 in all respondents who indicated using opioids at least 5 times in the previous 12 months (n = 236). RESULTS: A three-class model provided the best fit of all the models tested. Classes showed a spectrum of severity that was compatible with the DSM-5 classification. 'Legal problems' and 'desire to cut down' showed poor discrimination between classes. The weighted prevalence of OUD using DSM-5 was 20.7% higher than with DSM-IV. CONCLUSIONS: RESULTS support the grouping based on severity of symptoms, combining abuse and dependence into a single diagnosis, omitting legal problems, and addition of craving as a new criterion.

Population-based incidence and cost of non-fatal injuries in Iran: a consistent under-recognized public health concern.

OBJECTIVES: To investigate the incidence and determinants of non-fatal injuries, and the cost imposed on victims in an Iranian population aged 15-64 years. DESIGN: Cross-sectional household survey. METHODS: Three-stage probability sampling was conducted for selection of a representative sample of Iranians. Data on the demographics, history and cost of injury were obtained from face-to-face interviews and telephone calls. RESULTS: In total, 7886 subjects were included in this study. The annual incidence rate of all injuries was 905 (95% confidence interval 853-957) per 1000 population (approximately nine injuries per ten Iranians). The mean (±standard error) incidence rates of first aid injuries (FAIs; medical care not required) and medical-attended injuries (MAIs; medical treatment sought) were 737 ± 24 and 168 ± 12 per 1000 population, respectively. Young, urban females were at highest risk for FAIs, and single males were at highest risk for MAIs. The most common injury description was as follows: non-paid work (activity), home (place), inanimate mechanical force (mechanism), upper limb (site of injury) and open wound (type of injury). For MAIs, the most common place of treatment was hospital. Traffic-related injuries had the highest total cost and the lowest out-of-pocket cost. Total and out-of-pocket costs of non-fatal injuries in Iran in 2011 have been estimated to be US$6,111,138,000 and US$1,480,411,000, respectively. CONCLUSION: Non-fatal injuries are an under-recognized public health problem. Cost-control policies are essential to reduce the out-of-pocket cost of injuries.

A nationwide population-based study on incidence and cost of non-fatal injuries in Iran.

BACKGROUND: Elucidating the epidemiological status of injuries is a critical component of preventive strategies in countries with high incidence of injuries, like Iran. Population-based surveys are able to estimate all types of non-fatal injuries. OBJECTIVES: This study protocol is the core unit in describing Iran's national cost and epidemiology of non-fatal injuries, and also as a guide for other studies. STUDY DESIGN AND METHODS: In a cross-sectional study, 1525 primary sampling units are randomly selected with probability proportional to size regarding the number of households in each enumeration area based on Iran's 2006 national census. Six of the households are randomly selected. One member of each household is chosen using Kish Grid tables. In all, 9150 subjects are selected. Data on demographics are collected. For each injury during the past three months, activity, place, mechanism, site, type and the place of treatment are coded to match the International Classification of Diseases, 10th revision 2012 (ICD10-2012) classifications. Subjects are contacted via telephone to obtain data on cost of injury. Finally, sampling weights are calculated so that data for each respondent can be inflated to represent other individuals in Iran. Quality control and quality assurance issues are discussed. DISCUSSION: Our objectives will describe the present impact and the future priorities of injury prevention in Iran.

Association of cigarette excise taxes and clean indoor air laws with change in smoking behavior in the United States: a Markov modeling analysis.

The rates of cigarette smoking in the United States have declined over the past few decades in parallel with increases in cigarette taxes and introduction of more stringent clean indoor air laws. Few longitudinal studies have examined association of taxes and clean indoor air policies with change in smoking nationally. This study examined the association of state and local cigarette taxes and clean indoor laws with change in smoking status of 18,499 adult participants of the longitudinal 2010-2011 Tobacco Use Supplement of the Current Population Survey over a period of 1 year. Every $1 increase in cigarette excise taxes was associated with 36% higher likelihood of stopping smoking among regular smokers. We found no association between clean indoor air laws and smoking cessation nor between taxes and clean indoor air laws with lower risk of smoking initiation. Cigarette taxes appear to be effective anti-smoking policies. Some state and local governments do not take full advantage of this effective policy measure.